Not success with Levemir insulin

Hello.You see, I had been with Lantus for 10 years and with novorapid but according to the latest results, my new endocrine (he has led me that the girl who took me was no longer) decided to change my insulins.

He put the sensor 2 times.What we saw is that there is a decrease in response to 2/3 in the morning at values ​​below 90 but it was 4/5 in the morning.This causes me to get up with high values ​​due to "rebound effect."
With a first result I took off the lantus and put the toujeo and it was very bad since my blood glucose became a low rise of hypos to hyper.

This time I take off the toujeo and put the aforementioned levamir and apride and the thing more or less goes during the day, but they continue the crazy mornings.

The guideline starts from Levemir was 22 units at night and 13 in the day (at breakfast).I kept getting up with high values.
I went up from unity in unity as it indicated until reaching 23 units at night and 12 at breakfast.
I started well, but not always.I explain myself, I have been taking data for 3 weeks and I can't find a pattern.

One day Ceno 10 rations (A unit by ration according to pattern and correction guidel

.- I repeat with 90 in blood and get up with 120;
.- Next Night 102 in Ceno Blood 12 rations, 12 of Ap of Lavemir, awake with 125
.- Next 125 in blood, Ceno 10 rations 10 of apride and 23 read, and awake with 243
.- Another 93 night in blood, 11 rations 11.5 Aray ,, 23 L and awake with 250
.-80 in blood, 10 rations, 9.5 apride, 24 Levenir and awake with 341
.- 197 in blood, 11 rations, 13.5 apride, 24 Levemir and awake with 281
.- 127 in blood, 10.5 rations, 11 ace

During the day I go like a clock but I am not successful in the morning.It has dropped dose (in case I got too slightly and made the rebound, I have risen in case I was short, I have arrived to repeat dinner when the value before it was similar to the previous day, clicking in different areas, before and afterof dinner, changing needles just in case every nothing ..). I have 2 or three good days and then 5 bad until something happens and I correct myself and I have been almost 2 months.Until April I do not have to return and the question, to those who have more way is ...

Why not success with the pattern in the morning with this insulin?

I have been doing night controls and I bought a sensor myself and I have hypos (low to 60 on average around 3/4 in the morning and then bounce, do whatever you do) for what I then have rebounds, but noThe means of controlling them with everything I have tried.

I don't know why I changed, if with my novorapid and my lantus (which have accompanied me from my debut to type 1) I was going well.Someday that you got out but it was never reached to these values ​​(180/190 3 or 4 days a month, or one point timely every much passed from 200 but passes from 220 never from my debut and since I learned to catch the tinoto guidelines and rations).

Thank you.

Go back to Lantus

Hello!
What is the 2H postcena control like?
What time do you have dinner?
Now that you carry the sensor, if you do not drop the 3 a.m., do you also have that progressive climb?

How is the rest of the profile on average?

What I had seemed to me is that you had a phenomenon of ALBA (more than a rebound), and I guess that's why they changed you to Levemir, because it makes a "plateau" (more than a peak) at 6-7 hours ofPut it, to try to coincide with your phenomenon of ALBA and thus be able to control it.

If the Alba phenomenon is very pronounced, it cannot be controlled with bolis and, most importantly, it has a negative impact on your HBA1C, the insulin pump can be assessed (but I think you can try many things before).

What time do you put the Levemir?I use it and considering that it lasts between 14-16 hours, it is important to control the hours.By putting it at breakfast basal and for the day you do well.
Have you tried to reduce carbohydrate intake at dinner?You may have to have dinner a little less and your problem is solved in part.

Thanks for your responses.Ceno at 21/21: 30 and there is a first time.At 10:30 in the morning, at lunch, the second time.The truth that I have not taken into account the overlap.On the other hand, if I reduced the intake of hydrates at dinner, I already tried without modifying the uncontrolled pattern.There were days that dawned well and days that triggered.
Anyway, the bomb is on the horizon, it is already valuing the endocrine because its reasoning, with the data that I am happening is close to what Endocrinantinewage expresses.The decline is progressive but the climb is faster.At 2 hours, the values ​​are usually good, with averages of between 100/130, as I see in my notebook.Progressive drop of about 4 hours on average.I tried to eat something at midnight, but I got up that day with 320 and did not repeat this test to contrast whether or not the case was repeated.With the sensor data that I have had these days from behind, it is seen that the climb is quite fast (in less than 2 hours) when the night drop is slower.The 14 days that the sensor has lasted, every day there is endocrinaanti, with a climb.If I can already upload the photos of the graphics, which helps the same if you see it.Thanks for your time and answers.

Thanks for the data.If the postcena control is correct (100-130) and from there slowly to 60night) or lower the lighting of the night (and when I say down, I do not mean going down from 24 to 22 or, but something else (type 16-18). Maybe that descent is less pronounced, the descent is avoided, and maybe, there is no abrupt rebound.blow, then it looks like Alba phenomenon.

I already tried to lower the dose until 19 and although the low one exists, I get up high because that dose does not reach the needs of the night bolus.

The 3 Measures at 19/20 of Levemir made me wake up with (213-221-204).

Upload the rapid keeping the levenir between 22-24 (depending on the night and hydrates consumed) for the moment is the best option in terms of results but remain high (180/190 on average; except those isolated days that I comment on the firstPost that yes, that I get up with values ​​between 100/130;
Last night, for example, I arrive with 78 to dinner 21:10 more or less, cease 9 portions and uploaded the rapBefore 1 in the morning I had 60. I ate 8 cookies Maria.

I have dawned (I wake up at 6:30 –6: 35, which makes me measure and breakfast about 6: 45-6: 50) and I have given 311.

The bad thing is that I will not have strips to walk by looking at me 2 hours later.They give them fair to month (and with this of the cuts when the endocrine has asked me to make a week of analysis 2 hours and 4 hours later, negative if it does not give me more strips. So we go with the problem, in a yearI only managed to give me a sensor and another because I decided3 different insulins) and if I have been able to look at me this last weeks it is the ones I have not used because I had the sensor, but I do not carry it and have spent almost all the extra strips for having taken it.

Another fears is that all this move already starts to take its toll.Although the background in 2017 (in May) it went well, I just renewed the card in earlyThey asked me in the 2 last lines of the visual test screen.He is supposed to tell me that he would call me to give me date in March but I still don't have it.I will have to comment too.Salu2

A pair of screens of the latest sensor measures.They reflect well what I say.Fast climb.
In one of them I shoot me in a little or less an hour.in the other in two hours.

That rapid climb seems to be because the insulin falls.What happens if you upload the quick dinner?
The Lantus did well to put it at night?

It seems that the measures with Levemir 19 were not as high as when you drop.With which it seems that although you lack basal at the end of the morning, there was also a rebound component.

I also think as @"Regina" that you should lower the fast from dinner, because you can start from a postcena of 170 for example, you would not need to lower the levem so much and allow you not to go down at 3 am by putting 23 u 23 uHowever, if you get 23 U and parts of a post-just post (100-130), you drop and then the rebound to 300.

Why did you put 10.5 or instead of 7.5?

Regarding the topic of view, if the background is normal and glying is targets, it would not have to be affecting your results in visual tests.

Thanks for your comments.I will try how they comment and tell you.
The gyrhed has gone from an average of 7.6 (there I have been maintaining, 7.6- 7.7-7.5 ...) that had a 7.9 in the last review.There are 11 years of diabetic and the eye, because we will see it, the fact is that from the test in the review for the driving license, if I close the right eye and look only with the left, the small letters see them blurred.I see everything blurred and if it is small I don't know what it puts.Before I did not happen to me.In addition, the role of the header for the review and that they include it in the traffic data that I am diabetic but that I am fine and does not prevent me from circulation with vehicles have asked me to take another one, despite the fact that the card, with the updated medical report of the header doctor.That is, a header doctor will return to me.They also told me that machinery, trucks and buses do not allow me to drive without glasses.because I do not reach the minimum of view required with what lost in the left eye.What I run is the time that runs between one appointment and another, between trying and not trying an insulin or a pattern, since it ends up playing against me.What are we with the right pattern ... what?What affects me now stays, right?That is why I tire and fit here, which is a year of probatinas and worse.With the Lantus, he had one day, as I comment, 3/4 mornings a tall high per month.Someday, the most crazy, a bit of 200 was spent from the debut and catch the rhythm did not give values ​​of more than 220/230 at any time.Not like now.
Thanks from the heart for your contributions

There is always the option to return to Lantus if you were better with her.Being a year or two with HBA1C to 7.6% will probably not do anything in your eyes, calm.I believe that the priority is now to avoid that hypoglycemia of the 3 am, which I think is what bothers you the profile (lower the fast to a post of 170 or so and then adjust the slow until it is controlled as well as possibleThe morning glycemia. And if there is no way, value bomb.

Greetings!

I do not think that recommending postprandial hyperglycemia as a rule to have a good night is a good solution.170 -180 postprandial probably comes from even higher values ​​in previous hours.Regina has perfectly indicated what should be done, lowering the quick of dinner and raising the slowIn the blood that is able to avoid that climb in the last part of the morning, but at the same time compensates a bit of the fast and there is no hypoglycemia prior to the 3H of dinner, but it is in good values.
In summary, I think you have to do what @regina has indicated and you probably have good results.

The graph of January 9 if it seems alba effect but that of 5 starts at 3 in the morning to climb.Isn't it that day you needed another rapid bolus?
You can also delay the time of the Levemir so that the effect will cover part of the dawn, I do not know, about 23 hours if you are still awake.

I do not think that recommending postprandial hyperglycemia as a rule to have a good night is a good solution.170 -180 postprandial probably comes from even higher values ​​in previous hours.

Regina has perfectly indicated what should be done, lowering the quick of dinner and climbing the slow one, I fully agree with it
The slow and lowering the quick one said the two, just after Moñiño climbed the catches, in which it is clear that although he does not make the hiccup of the morning, then he has the abrupt climb.So I do not understand this distinction as we would have said substantially different things.The only difference is that I have put a postprandial goal as an example, from 170. But if you usually have 100-130 posts and we tell you that the rapid goes down, it is obvious that the post control will be higher.

But it does not mean splitting on the night of 170-180, but when the slow one will rise there will be more slow-circulating insulin in blood that is able to avoid that climb in the last part of the morning
I do not know what you consider an acceptable 2H control, but @moñiño has said that if part of a postprandial control of 100-130 and puts itself less lethame (19 has said), the climb has the same (look at the sensor's graphics).With which, if you want to avoid that climb up the slow and starting from a post of 100-130, it will drop the 3 a.m.That said, then your proposal is to lower dinner, but to what postprandial goal?Because if 170 is too high and with 130 it drops the 3.A.M ... Do you think it's good 150?Neither for you or me?Hehe I think that with a 150 he would continue to have the same problem: with 23 of Levemir he would do the hiccup at 3 a.m.And with 19 he would make the climb of the 6 a.m., as he has commented.

Anyway, I have not said at any time that none of this is the optimal solution, I have only said that it will be better than before (at least it will not rise to 300).Because what influences HBA1C more?Have a little high postprandial or spend midnight at 300?Then, when you have an HBA1C of 7%, if you want to improve, then more things will have to be considered (which may not with bolis are not possible).

endocrinaantinewage said:

I don't think that recommend postprandial hyperglycemia as a rule to have a good night is a good solution.170 -180 postprandial probably comes from even higher values ​​in previous hours.

I do not believe that a postprandial 170-180 control should be called "postprandial hyperglycemia", although it has been 220 for 30 minutes before that postprandial control.

Regina has perfectly indicated what should be done, lowering the quick of dinner and climbing the slow one, I fully agree with it

But it does not mean splitting on the night of 170-180, but when the slow one will rise there will be more slow-circulating insulin in blood that is able to avoid that climb in the last part of the morning
I do not know what you consider an acceptable 2H control, but @moñiño has said that if part of a postprandial control of 100-130 and puts itself less lethame (19 has said), the climb has the same (look at the sensor's graphics).With which, if you want to avoid that climb up the slow and starting from a post of 100-130, it will drop the 3 a.m.That said, then your proposal is to lower dinner, but to what postprandial goal?Because if 170 is too high and with 130 it drops the 3.A.M ... Do you think it's good 150?Neither for you or me?I think that with a 150 he would continue to have the same problem: with 23 of Levemir he would do the hypo at 3 a.m.And with 19 he would make the climb of the 6 a.m., as he has commented.

Anyway, I have not said at any time that none of this is the optimal solution, I have only said that it will be better than before (at least it will not rise to 300).Because what influences HBA1C more?Have a little high postprandial or spend midnight at 300?Then, when I have a 7%HBA1C, if you want to improve, then more things will have to be considered (maybe with bolis are not possible).

I do not do absolutely any distinction, I am nobody here to do it, but one more person who thinks like everyoneCase also seems to try to make dinner bolus not end in hypoglycemia, which does not indicate how you have recommended looking for a high postprandial, but other solutions that as you say with pen seem more complicated.I rectify then, saying my opinion: I think the two (apologize for not including before) are successful in the consolidation: if it goes up slowly, the basal will be able to control the blood glucose the hours after the bolus, also in my view, butYou have to go down from dinner.

jpr said:
I do absolutely no distinction, I am nobody here to do it, but a person who thinks like everyone else, neither more nor less ... It has not been in any case myintention and I never intend to argue with anyone

jpr said:
simply that in this case it also seems to me that you have to try that the dinner bolus does not end in hypoglycemia

is that for what Moñiño commented, I have understoodThat the dinner bolus does not end in hypoglycemia, since it says that its 2H post control is over 100-130 (and dinner at 9 pm), which I understand that the hypoglycemia of the 3 a.m.It was not the fault of the Bolo of the dinner, but of the slow one, starting from a post of 100-130.

jpr said:
jpr said:
If it goes up slowly, the basal will be able to control the blood glucose the hours after the bolus, also in my view, but it has to lower the dinner quickly.> I think that if you put 5 more units of levemir (for example) at 9:00 p.m. (when dinner) whose effect will be distributed over 12-18 hours, the effect it may have on postprandial control would be minimal(from my point of view).

But in the end, it is to try and see ...

Greetings!

Just one thing, in case it helps .. I, the only way to adjust my daughter, was modifying one in one unit.And on average on average, when I was a child.Changing a single insulin.And I waited two days to modify another, if necessary.I always gave me a good result to do so, little by little.

As a great moderator left here that has left the forum very recently for personal reasons, advise from here to a person a basal or fast insulin change with the few knowledge and data we have here of the person who writes personallyI consider that it is "very dangerous."The Internet is very dangerous and we do not know what kind of person with diabetes is on the other side of the computer.I on treatments with insulin I put what works for me or does not work to me but it will never occur to me to tell a forero what can do well;All changes have to be under the supervision of their endocrin@ and under their responsibility, I do not want to carry severe hypoglycemia or any other problem under my conscience.What I said cannot "recommend" from here anything to anyone because I repeat that it is very dangerous.-

I have already tried

ruthbia said:
the graph of January 9 if it seems alba effect but that of 5 you start at 3 in the morning to climb.Isn't it that day you needed another rapid bolus?
You can also delay the time of the Levemir so that the effect will cover part of the dawn, I do not know, about 23 hours if you are still awake.

I have already tried to change the time (advancing and delaying) of the lesson, both day and night.But it only varies one or two hours earlier, or then the climb.I normally inject it at 23. Go down at 9:30 p.m. and go to 00.00 to try.